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Overspends are another reason to move care away from hospital


The revelation in HSJ this week of significant overspends in 33 primary care trusts is a worrying indicator of problems ahead.

The total overspend from those 33 of around £100m in-year is hardly catastrophic, not least because some of their PCT neighbours are underspent.

Nearly all the PCTs cite growing activity in acute trusts soaking up their cash as one of the central causes

But it suggests an underlying weakness in the ability of more than one in five PCTs to control their budgets.

NHS Hounslow, for example, has formally suspended its standing financial instructions. That is a very unhappy place to be.

Nearly all the PCTs cite growing activity in acute trusts soaking up their cash as one of the central causes.

But this problem is not confined to those in deficit. As Andy McKeon, managing director of health at the Audit Commission, revealed last week, the entire 6.5 per cent PCT funding increase last year was swallowed by acute trusts, even though the tariff only increased by 2.3 per cent.

Although we will have to wait until the pre-Budget report on 9 December for the Treasury’s official spending projections, the strategic health authorities have already done their sums for 2011-12 onwards.

Despite health secretary Andy Burnham’s plea to managers not to conduct their own mini spending reviews, papers from NHS North East let slip that the SHAs have rightly done just that, and are assuming there will be a cash freeze in PCT allocations from 2011-12 to 2013-14. They say this implies an efficiency assumption of 4.5 per cent a year and a cash cut in the tariff.

Against this backdrop the Department of Health must have concerns about how some PCTs are going to cope over the next four years. The answer has to be to move significant volumes of care out of hospitals.

There are a growing number of PCTs leading the way in integrating services with local government and making progress on managing demand for acute services - Torbay, Liverpool and Birmingham East and North among others. They prove it can be done.

Overspends are another reason to move care away from hospital


Readers' comments (2)

  • And these 33 PCTs aren’t the full list as some SHAs have yet to declare their deficits. What about NHS Trusts and FTs? If this is like previous years when the NHS overspent many finance directors will not be reporting potential deficits for fear of SHA ‘intervention’ sometimes referred to as ‘support’ or ‘performance management’. Some will be asked to ‘revise’ their numbers.

    It’s absolutely right that acute trusts are seeing patients that could be better seen in the community or even ‘self care’. However, when patients are asked why they went to their local hospital, as McKinsey asked for the south central PCT alliance, the patients said they saw hospitals as a ‘one stop solution’, they had an emotional attachment to their hospital, they were confused or worried. Some patients were informed of the alternatives but referred anyway.

    The problem is complex but the patients know best and we don’t ask them enough. This is supposed to be a patient led NHS and not a professional led NHS, isn’t it? All of this of course assumes PCTs can commission which successive reports/assessments have demonstrated only a handful are even getting close. Is that because they don’t want to or more likely because they have too many targets / priorities / demands…

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  • Sun Tzu is mostly right (The Art of Wha?) However, need to be careful with the assumption that community care is cheaper - there isn't any really significant and broadly reliable data, although clinical outcomes certainly appear to be evidence based. In addition, there is that difficulty around fixed costs and assets - might be worth thinking about how the NHS can sweat them, especially given the coming financial storm.
    To paraphrase the venerable man "keep your Community Services close, but your hospitals closer still."

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